MEDICARE: DR. MARY E. MASON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101043869	VA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	0101043869	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250693	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PAR	OTHER	VA	VIRGINIA PREMIER HEALTH
4	PAR	OTHER	VA	AETNA
5	PAR	OTHER	VA	CORVEL/CORCARE
6	15578	OTHER	VA	SENTARA OPTIMA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	PAR	OTHER	VA	FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
9	-033	OTHER	VA	TRICARE/CHAMPUS
10	0633Y	OTHER	NC	BC/BS
11	PAR	OTHER	VA	CIGNA
12	PAR	OTHER	VA	MULTIPLAN
13	PAR	OTHER	VA	USA MANAGED CARE
14	236912	OTHER	VA	UHC/MAMSI
15	PAR	OTHER	VA	VIRGINIA HEALTH NETWORK

General Provider Information

NPI Number	:	1447226196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E. MASON MD

Provider Business Mailing Address
First Line	:	PO BOX 7068
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-0068
Country	:	US
Telephone Number	:	757-686-3508
Fax Number	:	757-686-0541

Provider Business Practice Location Address
First Line	:	1168 FIRST COLONIAL RD
Second Line	:	STE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2444
Country	:	US
Telephone Number	:	757-496-9020
Fax Number	:	757-481-0638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	06/29/2011

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